Bariatric Surgery Centers Don't Deliver Better Outcomes

TUESDAY April 21, 2009 -- Having bariatric surgery at hospitals designated as centers of excellence doesn't reduce a patient's risk of complications or death, a U.S. study finds.

Bariatric surgery restricts the amount of food a person can consume or digest.

To be designated centers of excellence by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery, bariatric surgery centers must meet certain guidelines, including: performing at least 125 operations per year; employing a bariatric surgery coordinator and personnel to do long-term follow-up on patients; and entering patient outcomes into proprietary databases, which requires trained staff and a subscription to a database.

Medicaid and Medicare patients are required to undergo bariatric surgery at designated centers of excellence, the researchers noted.

"These criteria make intuitive sense but lack an evidence base for their application," wrote study author Dr. Edward H. Livingston, of the University of Texas Southwestern School of Medicine and Department of Veterans Affairs, Dallas.

He analyzed data on 19,363 U.S. patients who had bariatric surgery in 2005, including 5,420 (28 percent) who had their surgery at centers of excellence. Overall, 6.4 percent of the patients developed complications, and 0.1 percent died in the hospital.

At centers of excellence, 6.3 percent of patients developed complications and 0.17 percent died, compared with a 6.4 percent complication rate and a 0.09 percent death rate at other hospitals, the study found.

The average length of stay was 2.6 days at both centers of excellence and other hospitals, but average costs per patient were higher at centers of excellence -- $11,527 vs. $10,984.

The study was published in the April issue of the Archives of Surgery.

"It has been shown that the minimal annual procedure volume required to be designated as a center of excellence [125 cases per year] does not necessarily result in better outcomes, and that the minimum volume requirement is not evidence-based. Most importantly, this volume criterion significantly restricts access for bariatric surgery care," Livingston said.

"Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted," he concluded.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.